=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043796378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID DEMASI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2018
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2951 MAPLE AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-1406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-592-4575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 TOWNSHIP ROAD 26
-----------------------------------------------------
City | CARDINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43315-9434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-592-4575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 023183
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------